Re: Make Medical school FREE !!


"SJ Doc" <SJ_Doc@xxxxxxxxxx> wrote in message
news:7dqij1ld43mjb7psfvhvcn3ds5hlohucah@xxxxxxxxxx
> On Mon, 26 Sep 2005 13:44:12 GMT, "George Conklin" (and
> *is* this guy any relation to Groff Conklin?) interjected comments
> in response to a post by "SJ Doc":
>
> Said Conklin earlier:
>>>> Having doctors graduate with a lot of debt is totally dysfunctional to
>>>> a
>>>>good medical system. It enables them to justify not serving rural and
>>>>inner city areas. BUT if education is to be free, and it should be,
>>>>then
>>>>we need to be able to assign people to areas where they are needed too.
>
> To which SJ Doc had replied:
>>> So who does the assigning? I did a couple of years in the National
>>> Health Service Corps (U.S. Public Health Service) after I'd finished
>>> my internship, and assignments were made to inner city and rural
>>> settings on the basis of political perceptions of need. Matters of
>>> economic viability (the practice of medicine is - like the practice of
>>> any profession where services are offered in the marketplace - a
>>> small business) went without consideration. Public relations,
>>> political connections, and pork were the determinant factors. Once
>>> an NHSC medical officer had completed his term of service, he/she
>>> generally headed for greener pastures.
>
> Says Conklin now:
>> As the AMA has pictured medicine, it is a small business as thought of
>>about 1900, in the era where a family would run a small store. It was a
>>high-cost way of doing business, as medicine has remained today. The
>>marketplace will always put more doctors in the suburbs and ignore rural
>>and inner city areas.
>
> Certainly the regulatory and medicolegal circumstances of the
> present "marketplace" will do so. Most of the costs of which
> you speak, however, are related less to the actual practice of
> the medical arts (at least in primary care, where the question
> of "access to health care" is chiefly answered) than to the en-
> tirely secondary expenses of coping with third-party payers,
> professional liability insurance carriers, and the plaintiff's bar.
>
> Shortly after I set up in practice, I had to give up my largest
> treatment room, knock a hole in the wall to the receptionist's
> area, and turn that space into a business office, where I added
> two employees (one full-time, one part-time) to the payroll
> with not a patient care responsibility (beyond occasionally
> answering the phone) in their job descriptions. How truly
> good. One of the reasons for practicing in a group is the fact
> that this sort of expense - entirely extraneous, and imposed
> only by dint of third-party "cost management" (more like
> "cost-shifting") policies - can be efficiently shared among
> several physicians.
>
> And if you're lucky enough to find a fellow physician who ac-
> tually *likes* getting involved with juggling your group's ICD-9
> and CPT-4 coding, you can pretty much free-ride on this sort
> of strange and un-medical wonkishness. Elsewise, you've
> either got to learn how to do it yourself (talk about "kicking
> dead whales down the beach") or pay beaucoup bucks to
> a consulting firm to climb into your business office and do it
> for you.
>
> Then there's also the fact that when you're the only doctor in
> town - sometimes in the whole county - it's damned hard to
> arrange for coverage. I know one guy who was practicing
> in an NHSC post out in flyover country. He suffered an
> uncomplicated distal fibular fracture, x-rayed it and splinted
> it himself, and kept right on seeing patients. Bloody maniac,
> of course - but I did similar things at his age, too. When there
> is nobody to back you up, you play through the pain.
>
> Most guys coming into practice these days don't share that
> attitude. Most training programs are in major metropolitan
> areas, and most young physicians don't even get experience
> with independent decision making (and situations in which
> patient care depends upon their own personal resources and
> self-confidence). They're supervised and cozened and cod-
> dled all through their residencies - and you wonder why they
> don't want to strike out on their own in some windswept
> prairie where the only significant tourist attraction is the
> sight of the honest-to-ghod wagon wheel ruts of the Santa Fe
> Trail stretching forth to the horizon?
>


As you say, the small business approach to medicine is obsolete and does
not work very well. You have just proved that once again. Patients have
just as hard a time dealing with Medicare and insurance companies physicians
do.



> Not exactly the sort of place where your spouse (who almost
> certainly has a career of his/her own, in which he/she was
> occupied all through your training years) wants to settle down,
> either. As for the inner city....
>
> Have you ever had any experience treating the average inner
> city "poverty area" resident? You can fabulate all you want
> about finding the proverbial salt of the earth among them, but
> most of these people are completely contemptible.

Sad comment, really sad. My wife as a public health nurse dealt with
such a population her whole career. She found it very interesting work,
even the house calls on Xmas.


.

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